Chivako chemapapu inzvimbo yakagadzirirwa pamapapiro emapapu ose, ari panhengo yepakati (yepakati) yemapapu ose. Iyo chivako ndiko kunonzi bronchi , mabheti, mitsetse, uye mitsipa inopinda uye inobva mumapapu.
Anatomy yeHilum
Izvo zvose mapapu akanaka uye ari kuruboshwe ane chivako chinenge chiri pakati nepakati pasi pemapapu, uye zvishoma kumucheto (pedyo ne vertebrae kupfuura mberi kwebhokisi).
Papupa imwe neimwe inogona kuonekwa seine pepe (kumusoro) nheyo (pasi) mudzi uye hilus.
Iyo yakakura yebronchi, pulmonary arteries, pulmonary veins, uye mitsipa ndiyo zvivako zvinopinda uye zvichibuda mumapapu munzvimbo ino. Lymph nodes , inonzi hilar lymph nodes, inowanikwawo munzvimbo ino. Zvose zviviri zvikafanana nehupamhi, uye hilum iri kuruboshwe kazhinji inowanikwa zvishoma zvakanyanya mubhokisi kupfuura iyo yakakodzera hilum.
Imaging
Pamusoro pebhokisi x-ray, nzvimbo ye hilar inobudisa mumvuri unoumbwa nekubatana kwema-lymph nodes, mishonga yeplmonary, uye mishonga yemapmonic. Pamusana pekubatana kwezvivako izvi, dzimwe nguva zvinogona kuoma kuona kuwedzera kwemajini aya kana kuti kuvapo kwemazana munzvimbo ino. Ichi ndicho chimwe chezvikonzero nei chikwata chemazana x-ray chinogona kurasikirwa nekenza yemapapu .
Kufungidzira miedzo yakadai seC CT scans (zvikurukuru nekusiyana) kunogona kutungamirira pakuona zviri nani zvezvivakwa izvi.
Dzimwe nguva, kuongororwa kwakafanana nePET scan , bronchoscopy ne endobronchial ultrasound , kana mediastinoscopy inogona kudiwa kuti ione zviri nani nzvimbo yacho kana kuti iwane senzuro yebiopsy.
Abnormalities
Iyi nzvimbo yehairi yemapapu inogona kukanganiswa nemakumbo munzvimbo iyi (kusanganisira zvose zviri mumakumbo ekutanga uye zvipembenene zvinoshandiswa mumatenda), kuwedzera kwemajeri emakiromita, uyewo kusagadzikana kwemapiritsi emapirmoni kana mishonga.
Hilar Kuwedzera / Hilar Masses
Pane zvikonzero zvina zvakakonzera kuti chifukidzo cheimwe kana mapepa emapapu angaratidzika akawedzerwa pane x-ray. Izvi zvinosanganisira:
- Tumhe uye lymphadenopathy. Cancers dzakadai semapapu emapapu uye lymphomas, pamwe nekenza yakapararira kune ino nzvimbo kubva kune dzimwe nhengo dzomuviri (mastrainetic cancer) inogona kukonzera vanhu vakawanda munzvimbo ino. Zvimwe zvinokonzera kukwidziridzwa kwemakirini emaricho (lymphadenopathy) zvinokurukurwa pasi apa.
- Pulmonary venous hypertension (yakakosha mumasurupa emapurmonary). Pulmonary venous hypertension inogona kuitika nekuda kwehutano hwakadai sekushaya mwoyo uye zvinetso zvepfungwa dzemagetsi zvakadai semitral stenosis uye mitral kudzoka.
- Pulmonary arterial hypertension (PAH), kukwidziridzwa kwakanyanya mumapiritsi emapinmoni. PAH inogona kuitika sechirwere chepakutanga (kwete chechipiri kune imwe dambudziko) kana sechinetso chechipiri icho chinowanzokonzerwa nechirwere chisingaperi chinoparadza zvirwere (COPD).
- Kuwedzerwa kwemapemmonary blood flow. Mamiriro ezvinhu akadai se cyanotic congenital (chirwere chepfungwa chinokonzerwa nekuberekwa chinokonzera bhuruu yebhuruu kune ganda rinokonzerwa neakisijeni yakagadzikana) kunogona kukonzera kuwedzerwa kwemapemmari ropa.
Hilar Lymphadenopathy (Yakakurumbira Hilar Lymph Nodes)
Nhengo dzakakura dzakapetwa mumarimu dzinogona kuitika mune zvose zviri kurudyi uye zvakasara hilum (kuwirirana kwechirphydenopathy) kana parutivi rwega (kusagadzikana kwerymdendenopathy.) Zvinokonzera zvinogona kusanganisira:
- Kanza yemaperembudzi. Kanzira yemaperembudzi ndiyo inonyanya kukonzera kusaenzana kwenharaunda munzvimbo dzevanhu vakuru, zvose zviri zviviri nekuda kwekuvapo kwechirwere uye kuvapo kweiyo inosanganisira lymph nodes.
- Mamwe kanzira. Chirwere chematenda cheMetastatic chinogona kutungamirira ku hilar lymphadenopathy zvose nekuda kwekupararira kwekenza munzvimbo ino uye nekuda kwekubatanidza lymph nodes. Lymphoma nezvimwe zvirwere zvemuviri zvinogonawo kutungamirira pakuwedzera kwema-lymph nodes.
- Tuberculosis. Munyika yose, chirwere chetachiona ndicho chinonyanya kukonzera hular adenopathy muvana.
- Kuvhiringidza. Mamiriro ezvinhu akafanana sarcoidosis, amyloidosis , uye silicosis zvinogona kukonzera hilar lymphadenopathy. Sarcoidosis ndiyo inonyanya kukonzera kuwirirana kwechirwere chemajeri lymph node kuwedzera, kunyanya kune vechidiki vaduku. Irolar lymph node kuwedzera ne sarcoidosis inowanzoenzaniswa kune zvimwe zvinowanzokonzera. Kuita zvinodhaka kunewo chikonzero chinowanzovhiringidzika chekuchengetedza mahara.
- Zvimwe zvirwere. Zvirwere zvakadai sa mycobacteria, zvirwere zvehutachiona zvakadai sehutachiona hwemapukisa, berylliosis, tularemia, histoplasmosis, uye coccidiomycosis zvinogona kutungamirira kune lymph nodes yakakura munzvimbo ino. MuUnited States, histoplasmosis inowanikwa muOhio ne Mississippi Rwizi Valleys, ine coccidiomycosis inowanzosvika kumaodzanyemba kwakadziva kumadokero enyika.
- Zvimwe zvinokonzera. Castleman's disease chirwere chinoratidzika nechirwere chisina kuchena. Kukundikana kwemoyo kunogona kutungamirira kune hilar adenopathy.
Pasi Pasi
Kune huwandu hwemamiriro ezvinhu anogona kukonzera kutarisika kusingaoneki kwechikafu pane zvidzidzo zvekufungidzira, zvizhinji zvayo zvakakomba. Nhanho yekutanga, zvisinei, ndeyekuita nechokwadi kuti zvipi nezvipi zvitsva hazviiti nekuda kwekutadza kwemuviri kana uchitora mafirimu aya. Nehuwandu hwezvivako zvinopfuura nepakati penharaunda iyi, kunyange kutenderera kwakanyanyisa kunogona kupa kuonekwa kwechimiro kana pasina.
Mishonga, zvose zvakakosha uye zvinoshandiswa, zvinokonzera zvikonzero zvakanyanya zvezvikoro zvevanhu uye lymphadenopathy. Zvikonzero zvinowanzoitika zvinosanganisira tuberculosis pasi rose, uye mamiriro akadai sa histoplasmosis, coccidiomycosis, uye sarcoidosis muUnited States.
Kana chiremba wako akanyora kusakosha paunenge uchiongorora, kumwe kuedzwa kucharatidzwa. Anobvunzawo nhoroondo yakanyatsocherechedza kutarisa zvimwe zviratidzo zvinoratidza kufara, chirwere, kana kupisa. Kazhinji nguva iyo biopsy ichadiwa kuti iwane tsanangudzo yekujekesa.
Muenzaniso: John akaudzwa kuti kenza iri mukodhi yake yakarurama yakapararira kune hilar lymph node yake, lymph nodes pedyo nenzvimbo iyo bronchi inopinda mumapapu.
> Sources:
> Nin, C., De Souza, V., do Amaral, R. et al. Chirwere chinonzi Lymphadenopathy muBenign Zvirwere: A State of the Art Review. Respiratory Medicine . 2016. 112: 10-7.
> Sarkar, S., Jash, D., Maji, A., uye P. Anupam. Nzira yekusafananidza hilum pachipfuva X-ray. Journal of Association of Chest Physicians . 2013. 1 (2): 32-37.